Dermatology Flashcards
Clinical presentation of measles
Symptoms start 10 – 12 days after exposure, with fever (>40 classically) , coryzal symptoms and conjunctivitis
Koplik spots are greyish white spots on the buccal mucosa, appear 2 days after fever
rash starts on the face, classically behind the ears after fever , erythematous, macular rash with flat lesions.
Measles management
self resolving after 7 – 10 days of symptoms
Children should be isolated until 4 days after their symptoms resolve.
notifiable disease
Vitamin A for children in developing countries or that are malnourished or under 2 years old
Clinical presentations chicken pox
widespread, erythematous, raised, vesicular (fluid filled), blistering lesions
Once they scab, no longer infectious (usually around 5 days after the rash appears)
Fever is often the first symptom
Itch
General fatigue and malaise
Chicken pox treatment
usually a mild self limiting condition
Aciclovir may be considered in immunocompromised patients, adults and adolescents over 14 years presenting within 24 hours, neonates or those at risk of complications
itching can be treated with calamine lotion and chlorphenamine (antihistamine)
Patients should be kept off school and avoid pregnant women and IC patients until all the lesions are dry/crusted over, usually around 5 days after the rash appears
Clinical presentation of rubella
milder erythematous macular rash compared with measles. spreads face downwards but classically, the rash spares the limbs, as opposed to the rash of measles
mild fever, joint pain and a sore throat. lymphadenopathy
Rubella management
supportive, condition is self limiting. notifiable disease.
Children should stay off school for at least 5 days after the rash appears
should avoid pregnant women.
congenital rubella syndrome triad
deafness, blindness and congenital heart disease.
Roseola Infantum
caused by human herpesvirus 6
commonly seen in children between 6 months and three years
presents 1 – 2 weeks after infection with a high fever (up to 40ºC) that comes on suddenly, lasts for 3 – 5 days and then disappears suddenly
coryzal symptoms
When the fever settles, the rash appears for 1 – 2 days.
mild erythematous macular rash across the arms, legs, trunk and face, not itchy
Mx Roseola Infantum
Children make a full recovery within a week and do not generally need to be kept off nursery if they are well enough to attend
main complication to be aware of is febrile convulsions due to high temp
Clinical presentation Parovirus
fever rash and runny nose diarrhoea
lace-like rash in the trunk and arms, slapped cheek appearance, more in women and adults.
In adults, Parvovirus B19 presents with arthralgias.
Clinical features of Haemolytic uraemic syndrome (HUS)
haemolytic anaemia, an AKI and thrombocytopenia
associated with oliguria (very low urine output) and signs of anaemia. often presents in a child with recent diarrhoea
Aetiology of Idiopathic thrombocytopenic purpura
type II hypersensitivity reaction. It is caused by the production of antibodies that target and destroy platelets. This can happen spontaneously, or it can be triggered by something, such as a viral infection.
Epidemiology of Idiopathic thrombocytopenic purpura
children under 10 years old. Often history of a recent viral illness. onset of symptoms occurs over 24 – 48 hours:
Management of Idiopathic thrombocytopenic purpura
(platelets below 10):
Prednisolone
IV immunoglobulins
Blood transfusions if required
Platelet transfusions only work temporarily
Rituximab for resistant ITP
Azathioprine.
Consider splenectomy
Cause of impetigo
1.staphylococcus aureus (bulbous impetigo)
2.streptococcus pyogenes
Non-bullous impetigo
nose or mouth region
exudate from the lesions dries to form a “golden crust”
Topical fusidic acid can be used to treat localised
antiseptic cream (hydrogen peroxide 1% cream)
flucloxacillin is used to treat more wide spread/severe forms
Impetigo advice
Advice about not touching or scratching the lesions, hand hygiene and avoiding sharing face towels and cutlery. They need to be off school until all the lesions have healed or they have been treated with antibiotics for at least 48 hours.
Bullous impetigo
always caused by the staphylococcus aureus
1 – 2 cm fluid filled vesicles
grow in size and then burst, forming a “golden crust”.
lesions can be painful and itchy
more common in neonates and children under 2
may be feverish and generally unwell
usually flucloxacillin to treat
Epidemiology of Staphylococcal scalded skin syndrome
usually affects children under 5 years
Clinical presentation of Staphylococcal scalded skin syndrome
starts with generalised patches of erythema.
often causes erythroderma
skin looks thin and wrinkled, followed by the formation of fluid filled blisters called bulla
desquamation (peeling of the epidermis) and positive Nikolsky sign (gentle rubbing of the skin causes it to peel away)
Perioral crusting/fissuring is common, oral mucosa is usually unaffected unlike in TEN
Systemic symptoms
Staphylococcal scalded skin syndrome (SSSS) Mx
IV antibiotics e.g. vancomycin if methicillin resistant staphylococcus aureus is suspected
Fluid and electrolyte balance
Emollients and dressings to skin
Analgesia
When adequately treated, children usually make a full recovery without scarring.
Recovery is usually within 5-7 days
Nikolsky sign is positive in
SSSS, TEN and pemphigus vulgaris.
Bullous pemphigoid
autoimmune condition causing sub-epidermal blistering of the skin
deep, tense blisters. itchy
Unlike pemphigus, oral mucosa is rarely affected
Nikolsky sign is negative
Bullous Pemphigoid management
very potent topical corticosteroids eg Dermovate (clobetasol propionate 0.05%).
Pemphigus vulgaris
autoimmune disease
mucosal ulceration is common
skin blistering - flaccid, easily ruptured vesicles and bullae. Lesions are typically painful but not itchy
Nikolsky positive
Aetiology of Scarlet fever
group A streptococcus infection,usually tonsillitis, eg streptococcus pyogenes
Complications of scarlet fever
otitis media
rheumatic fever
acute glomerulonephritis
invasive complications (e.g. bacteraemia, meningitis, necrotizing fasciitis)
Clinical presentation of Scarlett fever
red-pink, blotchy, macular rash with rough “sandpaper” skin that starts on the trunk and spreads outwards. Patients can have red, flushed cheeks.
Systemic symptoms,Sore throat, Strawberry tongue ( red and bumpy), Cervical lymphadenopathy
Management of Scarlett fever
phenoxymethylpenicillin (penicillin V) for 10 days.
notifiable disease
Children should be kept off school until 24 hours after starting antibiotics.
Aetiology of warts
Infection of epidermal cells with DNA human papilloma virus
Aetiology of
Molluscum contagiosum
molluscum contagiosum virus, a type of DNA poxvirus.
NICE criteria eczema/atopic dermatitis
itchy skin + 3/5 of:
Visible flexural eczema*
History of flexural eczema*
History of dry skin in last 12 months
History of asthma or allergic rhinitis (or history of atopy in 1st degree relative if <4 years)
Onset of signs/symptoms <2 years old (do not use if <4 years old)
*or on the cheeks/extensors in children <18 months
What is Eczema herpeticum
dermatological emergency caused by a disseminated HSV infection or varicella zoster virus due to impaired skin protection as a result of atopic dermatitis. It results in a monomorphic vesicular rash which can ulcerate and crust. There may be systemic effects, such as fever. Diagnosis can be confirmed with a swab + Tzanck test. Treatment is with IV aciclovir
Drug triggers of psoriasis
B blockers, Anti malarial, Lithium, Indomethacin/nsaids (BALI)
Triggers of Guttate psoriasis
streptococcal throat infection, stress or medications.
What is Auspitz sign
refers to small points of bleeding when plaques are scraped off in psoriasis
nail features of psoriasis
nailed pitting , onycholysis (nail bed separation), subungal hyperkeratosis
Mx psoriasis
Topical steroids
Topical vitamin D analogues (calcipotriol/dovonex)
Topical dithranol/vit a analogue
Tazarotene/coal tar
Phototherapy with narrow band ultraviolet B light is particularly useful in extensive guttate psoriasis
Topical calcineurin inhibitors (tacrolimus)]
Systemic therapies:
Biologics
Topical steroids potency
Help every budding dermatologist
Mild- hydrocortisone
Moderate- eumovate
Potent- betnovate
Very potent -dermovate
open comedone
Blackhead
Cause of Hand foot and mouth disease
coxsackie A virus.
Incubation is usually 3 – 5 days.
Clinical presentation of hand foot and mouth disease
starts viral URT symptoms.
After 1 – 2 days small mouth ulcers, followed by blistering red spots across the body. Especially on the hands, feet and around the mouth.
Painful mouth ulcers, particularly on the tongue
The rash may be itchy
Mx hand foot and mouth disease
supportive, with adequate fluid intake and simple analgesia
resolves spontaneously without treatment after a week to 10 days
highly contagious, but if children are well can still go to school
Clinical presentation of
Erythema nodosum
red, inflamed, subcutaneous nodules across both shins. nodules are raised, can be painful and tender. Over time the nodules settle and appears as bruises.
Clinical presentation Erythema Multiforme
widespread, itchy, erythematous rash. Target lesions are red rings within larger red rings, with the darkest red at the centre, similar to a bulls-eye target.
can cause a sore mouth (stomatitis).
Can cause systemic symptoms
Causes of Erythema Multiforme
herpes simplex virus (causing coldsores)
mycoplasma pneumonia
penicillin use
